Let’s Talk About
Gout
Written by: Consultant Dietitian Megan Ang
What is gout?
Gout is a common form of inflammatory arthritis that affects the joints. In fact, it is one of the most prevalent forms of arthritis in Malaysia [1]. For many, symptoms such as pain and swelling often begin in the big toe but may also affect other joints in the lower limbs [2,3].
There are three stages of gout [4,5]:
Asymptomatic hyperuricemia: High uric acid levels without any symptoms.
Acute gout: Sudden and severe gout attacks that cause intense pain, often within 24 hours of onset.
Chronic tophaceous gout: Formation of densely packed crystals called tophi due to frequent gout attacks, leading to permanent joint damage.
As the condition progresses, it can cause extreme pain and significantly impact daily activities.
How do I get gout?
Gout develops due to a buildup of a substance called uric acid in the body. While uric acid plays an essential role as a powerful antioxidant, an excess can lead to problems [7]. This buildup may result from either overproduction or poor excretion, causing crystals to form in the joints, which in turn leads to pain and swelling.
What is uric acid?
Uric acid is a by-product formed when the body breaks down purines [5,6,7]. These purines can come from the body’s own cells or from purine-rich foods in the diet. The more purine-rich foods consumed, the more uric acid is produced.
As mentioned, uric acid itself is not harmful. It becomes a problem only when levels are excessively high. Persistently elevated levels can lead to crystal formation and accumulation in the joints [1]. However, not everyone with high uric acid levels will develop gout.
Am I at risk of getting gout? [1,2,3]
Risk factors include:
Gender (more common in men)
Age (risk increases with age)
Family history of gout
Health conditions such as obesity, high blood pressure, congestive heart failure, diabetes, kidney disease, and kidney stones
Diets high in purines, alcohol, and fructose
Certain medications (e.g., diuretics, low-dose aspirin, excessive B3, cyclosporine)
How can I manage my gout? [6,9]
Medical Management
Medical treatments aim to reduce the pain of gout flares and lower uric acid levels.
Medications used during gout attacks include:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Colchicine
Medications used to lower uric acid levels include:
Allopurinol
Febuxostat
Probenecid
Note: Some medications may have side effects. Always consult your doctor to find a treatment that suits you best.
Dietary and Lifestyle Modifications
With proper dietary and lifestyle changes, future gout attacks can be prevented by reducing uric acid levels in the body.
Maintaining a Healthy Weight
Maintaining a healthy weight can significantly reduce the risk of gout [2,3,5,6]. Body Mass Index (BMI) can serve as a general guideline. If overweight, losing weight through healthy eating and regular exercise can help lower uric acid and reduce joint stress, particularly in the lower limbs.
Physical Activity
Aim for 30 minutes of exercise daily, or 150 minutes per week, to help manage weight and lower the risk of gout [2,6]. Start with low-intensity activities like walking and gradually increase as your fitness improves. Exercising with friends or family can make it more enjoyable.
Diet
Choose lower purine foods: [3,5,7,8,9]
Tart cherries (fresh, frozen, juice, or powdered)
Low-fat dairy (milk, yogurt, cheese)
Fruits and vegetables
Eggs
Grains and cereals (rice, noodles, bread)
Reduce intake of: [3,5,7,8,9]
Organ meats (liver, kidney)
Red meats (beef, lamb) and poultry (chicken)
Certain seafood (sardines, anchovies, tuna, mackerel, mussels, cockles)
Alcohol (all types – limit to 1–2 standard drinks)
High-fructose beverages
While some vegetables such as mushrooms, asparagus, cauliflower, and spinach are higher in purines, research shows they don’t significantly raise uric acid levels. Therefore, focus more on reducing purine-rich animal products rather than plant-based foods [8,5].
Hydration is key. Drinking plenty of fluids, especially water, helps promote the excretion of uric acid through urine [5].
Summary
Gout is a well-researched and manageable condition. Effective strategies, including medication, diet, and lifestyle changes, can help prevent painful flares and support joint health. By working with healthcare professionals and making informed decisions, those with gout can live well and stay pain-free.
Reference List
- Wan Rohani WT, Mahfudzah A, Nazihah MY, Tan HL, Wan Syamimee WG, Amanda Jane PG, et al. Association of solute carrier family 2, member 9 (SLC2A9) genetic variant rs3733591 with gout in a Malay sample set. Med J Malaysia. 2018;73(5):307-10.
- Gout [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2022Nov5]. Available from: https://www.cdc.gov/arthritis/basics/gout.html#:~:text=quality%20of%20life%3F-,What%20is%20gout%3F,no%20symptoms%2C%20known%20as%20remission.
- Gout [Internet]. National Institute of Arthritis and Musculoskeletal and Skin Diseases. U.S. Department of Health and Human Services; 2021 [cited 2022Nov5]. Available from: https://www.niams.nih.gov/health-topics/gout
- Doherty M, Jansen TL, Nuki G, Pascual E, Perez-Ruiz F, Punzi L, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012;71(11):1765-70.
- Gandy J. Manual of Dietetic Practice. Chichester: Wiley Blackwell; 2019.
- Department of Health & Human Services. Gout [Internet]. Better Health Channel. Department of Health & Human Services; 2000 [cited 2022Nov5]. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gout
- Jakše B, Jakše B, Pajek M, Pajek J. Uric Acid and Plant-Based Nutrition. Nutrients. 2019;11(8).
- Aihemaitijiang S, Zhang Y, Zhang L, Yang J, Ye C, Halimulati M, et al. The Association between Purine-Rich Food Intake and Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents. Nutrients. 2020;12(12).
- Pillinger MH, Mandell BF. Therapeutic approaches in the treatment of gout. Seminars in Arthritis and Rheumatism. 2020;50(3, Supplement):S24-S30.
